History of Pharmaceuticals: From Drugs to Medicines

Since ancient times, plants such as cannabis, opium poppy, mandrake and opium have played crucial roles in traditional medicine as well as in religious rituals and cultural practices. These plants, considered at different times as remedies or poisons, reflect the complex relationship that humankind has maintained with the natural world and its resources.

Today on the Cannactiva blog we invite Jorge Melero, and Jorge Escohotado, partners of La Emboscadura, the monographic publishing house of Antonio Escohotado, the famous author of General History of Drugsto talk about the concept of Phármakon.

Drug Concept: The Meaning of Phármakon

The concept of a drug has evolved significantly throughout history, adapting to changing cultural and scientific perceptions.

Originally, the Greek word phármakon encapsulated an inherent duality: remedy and poison, a meaning that transcends the mere categorization of substances. As we move through history, from the early treatises of Hippocrates to modern interpretations, we find that the notion of a drug has always been linked to an understanding of its contextual and dosimetric effects. This semantic and functional complexity reflects the deep interconnection between medicine, philosophy, and sociology, highlighting how the words we use to describe drugs can influence our perceptions and experiences of their effects.

Drug or drug: The impact of language on perception.

Perhaps the eternal philosophical question lies in understanding whether concepts shape our perception or are only symbols that give it a name.

The Sapir-Whorf hypothesis (Parra, 1988) tells us that language completely shapes your perception of reality. Some Eskimo tribes, for example, have multiple words to name types of white, so they distinguish varieties that other humans cannot. This is especially interesting with regard to pharmacology, Does the terminology you give to a drug change the effects it has on you? Do your beliefs end up determining part of reality?

This question is certainly complex, however, the existence of placebos in all drug studies shows us that in effect the conception of the substance you take has a direct impact on the effect it has on you. Therefore, we must ask ourselves whether the terminology used, in this case drug or medication, can have a direct effect on the consumer, whether the stereotypes that we directly relate to each drug end up shaping the reality of them.

Origin and etymology of the word ” drug”.

The word drug is currently defined by the Spanish Royal Academy of Sciences as: “Medicament elaborated with a specific molecule”, while the word medicine is defined as: “Substance that, administered internally or externally to an animal organism, serves to prevent, cure or alleviate disease and correct or repair its sequelae”. Therefore, only those substances that, made with a specific molecule, try to mitigate a disease are considered drugs.

However, its origins are found in the Greek word phármakon whose meaning is much broader: “The Greek word phármakon has the double meaning of poison and remedy, a single word to give life and to give death” (López, 2021, p. 1). If we turn to the dictionary, we can see how this word has been stripped of part of its meaning:

Phármaco is a polysemous word, its grammatical gender is neuter and it can mean both remedy and poison; intoxicating drink, filter; or even spell, magical operation. (…) (phármakon): remedy, medicine, medicinal drug [concoction, powders, ointment]; poisonous drug, poison; magical drug or concoction, drinkable, filter; magical operation, incantation; fig. secret means or remedy (Pabón, 2014, p. 617).

We can even inspect its etymology more deeply: “it is a compound term, with a first part meaning “to transfer” and a second part meaning “power”. In that case, fármaco would be ”[lo que] has the power to transfer [impurezas]” (Escohotado, 1998, p. 28).

Until Hippocrates, “any simple or compound body capable of modifying the mood” (Escohotado, 1998, p. 28) was perceived as magic.

Therefore, we may ask ourselves, were the Greeks so ignorant that they could not distinguish a remedy from a poison? Of course, we would have to be too incautious to subscribe to such a statement. As the physician and alchemist Paracelsus, considered the father of toxicology and famous for his important contributions to medicine, would say much later: “sola dosis facit venenum”, or “only the dose makes the poison”(Escohotado, 1998, p. 80).

This is how the drug was considered in ancient Greece where, far from attributing moral faculties as good or bad to substances, it was clear that their usefulness lies in the quantities. It is common knowledge that even something as indispensable for life as water could end up being a cause of death if more is ingested than the organism can withstand. In the first treatise on botany written in the fourth century B.C., History of Plants, Theophrastus, who curiously lived to be 85 years old, something uncommon at that time, states the following:

One drachm is given if the patient should simply cheer up and think well of himself; double that dose if he should become delirious and suffer hallucinations; triple if he should become permanently insane; a quadruple dose is given if the man should be killed (1483).

Philosophy and ethics in the use of medicinal substances

The scientific conception of the substance contemplated its use for multiple purposes depending on its proportions, however, to accept this reading of pharmakon as the only one would be to incur in a superficial analysis of the term.

In Plato, for example, we find an approach that goes further:

It should be known, in fact, that Plato distrusts pharmakon in general, even when it comes to drugs used for exclusively therapeutic purposes, even if they are used with good intentions as in the case of medicine, and even if they are as such effective, as in the case of psychopharmaceuticals. There is no such thing as a harmless remedy, the pharmakon can never be simply beneficial (Derrida, 1975, p. 110).

Remedy and poison, cure and harm, are intertwined in such a way that any attempt to use pharmakon inevitably involves an inherent risk and thus requires considerable ethical responsibility. It is curious that pharmakós, a word very similar to pharmakon, means scapegoat in Greek:

It is quite remarkable that the Greek word for drug is phármakon, and that pharmakós – changing only the final letter and the accent – means scapegoat. Far from being a mere coincidence, that shows to what extent medicine, religion and magic are inseparable in the beginning (Escohotado, 2018, p. 14).

According to the RAE, scapegoat is nothing more than: “A person on whom others are blamed in order to exonerate the real culprits”. In other words, a scapegoat who absorbs responsibility for actions he did not commit.

This may apply to illicit drugs, placing on their shoulders burdens that do not correspond to them, as we have indicated above, substances do not appear to be good or bad in themselves, they do not deserve to be demonized or vilified, but their use, and especially their abuse, is what determines their effect on the consumer.

Hippocrates and the Rationalization of Medicine: Separating Magic from Science

If we go back to the dawn of scientific medicine, the Hippocratic Corpus (Hippocrates, 1987) marks the division between practices dedicated to healing and those dedicated to procuring evil, and more specifically it detaches this discipline from techniques that are based on healing through harm to third parties, as with the use of sacrifices. It ends with the scapegoating of the pharmakós to grant, rightly, the power to the phármakon, establishing a rational approach through experimentation and deep knowledge of medicines:

By delinking his acts from magic and religion, the Hippocratic denies validity to any cure based on a symbolic transfer of evil from someone to another, thus breaking with the institution of the scapegoat. Instead of using some pharmakós or goat to absorb the impurity of others, the new medicine will use the phármakon or appropriate drug (Escohotado, 2018, p. 26).

In the treatises of Hippocrates we also find no distinction between drug and drug, Hippocrates says that “drugs are substances that act by cooling, heating, drying, moistening, contracting and relaxing, or making sleep” (Hippocrates, 1987, p. 246).

Evolution of pharmacology: From Theophrastus to modern euthanasia.

The aforementioned History of Plants by Theophrastus (1483) provides an early list of experts who were professionally engaged in pharmacology (Escohotado, 1998), and indicates that almost all regions at that time practiced the production of drugs to a greater or lesser extent. Here again, there is no linguistic difference that distinguishes drug from medicine.

It is interesting to highlight the concept of drug tolerance, introduced, according to Theophrastus, by Thrasias of Mantinea and his disciple Alexias, who pioneered the conceptual formulation of individual differences in the assimilation of drugs:

The virtues of all drugs become weaker for those who get used to them, until they become completely ineffective in some cases…. For it seems that some drugs are toxic because of unfamiliarity, and perhaps it is a more accurate way of speaking to say that familiarity takes away their poison from drugs, because they cease to be toxic when the constitution has accepted them and prevails over them, as Thrasias observed; for he said that the same thing was a drug for one and not for another, distinguishing between different constitutions, and he keenly observed the difference. (Theophrastus, 1483, p. 17).

In this society, habituation was not seen as a problem, but as a positive adaptation that allowed individuals to live with substances without suffering their negative effects. In addition, Trasias was recognized for discovering a sweet euthanasia, capable of inducing an easy and painless death, evidencing an advanced and humane approach to the use of drugs.

It seems that in Spain we have recently rediscovered this approach through laws such as Organic Law 3/2021, of March 24, on the regulation of euthanasia, which opened up the possibility of autonomously deciding the application of euthanasia, a right that some consider basic, while others repudiate it. At present, this subject is not without controversy and problems arise, such as conscientious objection on the part of most physicians when it comes to applying such practices. The interpretation of the Hippocratic Code is essential here, perhaps both points of view can be considered humanistic, but the key lies in determining whether a harm is being done to the patient or, on the contrary, a good.

Conclusion

In conclusion, the evolution of the concept of phármakon over the centuries shows us the complexity and ambiguity inherent in the nature of pharmaceuticals.

From ancient Greece to the present day, we have observed how these substances have been interpreted and reinterpreted according to cultural, philosophical and medical contexts. The original duality of the Greek term, encompassing both remedy and poison, is still relevant today, especially when we consider the impact of placebos and the importance of consumer perception.

This semantic and practical evolution of the drug concept underscores the need for a nuanced and critical understanding that recognizes not only the chemical effects of substances, but also the power of the words and beliefs that surround them.

Jorge Melero and Jorge Escohotado (Los Emboscados), in Madrid on 28/12/2024

References

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